HPV Vaccine Gardasil 9 for Boys

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Gardasil-9 is a vaccine that protects against human papillomavirus (HPV), a virus that is spread through sexual contact. HPV vaccination prevents nine high-risk types of HPV linked to cancer, most predominately cervical cancer but also cancer of the anus, vagina, vulva, penis, mouth, tonsils, and throat.

Gardasil-9 replaced the original HPV vaccine, Gardasil-4, in 2017.

Teenage boy (12-13) bracing himself for injection
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When the original Gardasil was first approved by the U.S. Food and Drug Administration (FDA) in 2006, it was recommended for girls and women ages 9 to 26 only. It was only in 2009 that the recommendations were expanded to include boys and men 9 to 26.

In 2018, the FDA further expanded its recommendation so that men and women ages 27 to 45 can opt for HPV vaccination after consultation with a physician.

Gardasil-9 is today the only HPV vaccine approved for use in the United States following the voluntary discontinuation of Cervarix (which protected against two HPV types) in 2016.

Rationale

The FDA and Centers for Disease Control and Prevention (CDC) decided to extend the use of Gardasil to boys based on studies that showed that HPV increases the risk of anal cancer by 17- to 20-fold in men and women and that the risk in men who have sex with men (MSM) may be increased by as much as 70-fold.

Moreover, over 30% of penile cancers are known to be linked to two specific HPV types, type 16 and type 18. These are two of the types targeted by Gardasil-9 and the ones linked to the majority of cervical cancers, anal cancers, and other HPV-associated cancers.

What's more, the virus is spread through sexual contact, which means that a male who is infected with HPV can pass it to another male or female. By preemptively vaccinating boys before they are sexually active, the spread of infection can be reduced along with a boy's risk of anal, penile, and oropharyngeal (mouth and throat) cancer in later life.

Gardasil 9 protects against seven high-risk types of HPV associated with cancer (types 16, 18, 31, 33, 45, 52, and 58) and two low-risk types associated with genital warts (types 6 and 11).

HPV Infection in Boys

According to the CDC, an estimated 79 million people in the United States are infected with HPV. There are over 200 types of HPV, 40 or so of which are sexually transmitted. The majority do not cause cancer, and some cause no symptoms at all.

Genital Warts

A handful of low-risk HPV types are responsible for genital warts, of which 90% are linked to HPV types 6 and 11. In males, warts may occur on the penis, scrotum, testicles, anus, groin, or thighs.

In most cases, genital warts pose no major health risks, although they may be unsightly and embarrassing. Some will resolve on their own; others may require medical treatment to remove them (although recurrence is common).

Cancer

However, the types of HPV that can cause genital warts are not the same as the types that can cause cancer. Most people who become infected with these do not know that they have been infected.

These high-risk types, referred to as oncogenic HPV, can sometimes linger and cause normal cells to turn cancerous—although it is not entirely clear why. While the type of HPV plays a large role in this, so can co-occurring conditions like HIV, which is already linked to an increased risk of many types of cancer.

In men with HPV and HIV, the incidence of anal cancer is roughly 78 per 100,000 compared to only 2 per 100,000 in the general population. Some studies have suggested that the rate may be as high as 168 per 100,000.

Recommendations

The CDC recommendations for HPV vaccination are the same for boys and girls. The ideal age to receive Gardasil-9 is between 11 and 12, when most people are not yet sexually active. It can be given to individuals as young as 9 who make be at risk of sexual exposure.

Anyone up to the age of 26 should also be vaccinated if they have not previously done so or have not completed the recommended series.

Even so, vaccination during the preteen years is preferred as people are less likely to have been exposed to the virus and generally have a better immune response.

HPV vaccination is highly effective in people who have not been exposed to the HPV types that Gardasil-9 protects against. It may be less effective in those with risk factors for HPV, including adults with multiple lifetime sex partners.

The recommended dosage of Gardasil-9 varies by age.

Group Dose Schedule
Ages 9 to under 15 2 •First dose ideally between 11 and 12
•Second dose 6 to 12 months later
Ages 15 to 26 3 •First dose
•Second dose 1 to 2 months later
•Third dose 6 months after the first dose
Ages 27 to 45 3 Same as for 15- to 26-year olds

It is important to note that while the FDA approved HPV vaccination in people ages 27 to 45, the CDC recommends "shared clinical decision-making" regarding HPV vaccination in this age group.

This is because is benefits of vaccination may be low given that the majority of people will have already gotten HPV by the time they are 27. By discussing your medical and sexual history with your doctor, you can decide whether HPV vaccination is appropriate.

According to the CDC, HPV is so common that nearly all sexually active men and women will get the virus at some point in their lives.

Side Effects

In clinical trials, Gardasil-9 was found to be safe and effective, although it may cause mild, transient side effects in some people, including:

  • Pain, redness, or swelling at the injection site
  • Fever, usually mild
  • Nausea
  • Dizziness
  • Headaches
  • Muscle or joint pain

Gardasil-9 should not be used by anyone who has had a hypersensitive reaction to a prior dose of the vaccine.

A Word From Verywell

HPV is the most common sexually transmitted infection in the United States. While HPV will usually go away on its own, this shouldn't suggest you should take any chances with your child.

Unlike most vaccines recommended by the CDC, HPV vaccination is mandated by only a small handful of states. In fact, as of 2020, only Hawaii, Rhode Island, Virginia, Washington, D.C., and Puerto Rico required HPV vaccination in school children.

It, therefore, leaves it up to you as a parent to get your child vaccinated if your state or school does include Gardasil-9 on its vaccine schedule.

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